Provider Demographics
NPI:1730176405
Name:VIETS, EDGAR LEE (DC)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:LEE
Last Name:VIETS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2199 CREST ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4719
Mailing Address - Country:US
Mailing Address - Phone:541-882-6512
Mailing Address - Fax:541-884-3044
Practice Address - Street 1:2199 CREST ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4719
Practice Address - Country:US
Practice Address - Phone:541-882-6512
Practice Address - Fax:541-884-3044
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR00WCKFMCMedicare ID - Type Unspecified
ORT68218Medicare UPIN